Pipeline embolization device as a standalone curative approach for recurrent sigmoid sinus DAVF

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Dural arteriovenous fistulas (dAVFs) are abnormal connections between dura mater arteries and veins.
• Post-surgical dAVFs, particularly after meningioma resection near dural sinuses, pose treatment challenges.
• Recurrent dAVFs can lead to significant neurological deficits.

Purpose of the Study:

• To report a case of recurrent sigmoid dAVF following meningioma resection.
• To evaluate the efficacy of a pipeline embolization device (PED) in treating a complex dAVF.
• To highlight flow diversion as a reconstructive treatment for dAVFs when conventional methods are unsuitable.

Main Methods:

• A 74-year-old male with recurrent sigmoid dAVF after meningioma surgery was treated.
• Conventional treatments (transvenous/arterial embolization, sinus sacrifice) were deemed unsuitable due to dominant sigmoid sinus.
• A reconstructive approach using a pipeline embolization device (PED) construct was employed.

Main Results:

• The PED successfully occluded the dural arteriovenous fistula.
• The reconstructive approach preserved the function of the dominant right sigmoid sinus.
• Follow-up angiography confirmed stable dAVF occlusion and normalized intracranial venous drainage.

Conclusions:

• Flow diversion with a PED is a viable treatment for complex dAVFs.
• This technique is particularly useful when preserving venous sinus function is critical.
• Pipeline embolization offers a reconstructive alternative for dAVFs unsuitable for conventional therapies.